Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Sunday, September 30, 2007

I sympathize with my consultants for reasons that have been presented here ad nauseum. Still, there are folks on our call list that are master dodgers and defer-ers and general pains in the ass to deal with... Docs who honestly believe that I MEAN to cause them pain by referring sick patients to them. Over the course of months these asswipes sort themselves into a small but real group of bad people. Up to now I have had no way to exact revenge on them but now I do. All fellow travellers take note of this delicious strategy. For the sake of this post let's assume that the asswipe referral doctor is called "Dr. Z".

Of the two or three patients I see per day that want so badly to be sick but just are not, that have 'non organic' symptoms and have been studied out the wazoo, that have, say, "10 out of ten pain, doc, it goes from my pinky toe to my left eyeball and makes my heart stop" I will now do the following.

Me: "Ma'am, I'm afraid that you may have either Fibromyalgia or Chronic Fatigue Syndrome. Just check online and you will see that there are a lot of folks with this problem and I know once you read the symptoms you will know this is what you have. You may want to go ahead and join a support group and print out as much stuff as you can. Now, this is a difficult diagnosis to make in the Emergency Department but take heart! Dr. Z out in town is a national expert in these problems. I recommend giving him a call tomorrow and understand, he's a busy man, but if you just persist a bit he will see you. He may be able to do some specific procedures and tests that will cure you. Good bye and good luck."

Patient: "Oh thank you doctor. I will call Dr. Z in the morning and insist on being seen!"

Nice..Years ago we could just "suggest" which surgeon, ortho, etc was the best and I'd give the "nice" pts to my friends and say they were "asked for" by the pt (or the guys who always helped when needed) and give the POS's to the on call asshole. But now, everybody wants to dodge the ED call, even the ones with insurance!!

Here's the deal: you shouldn't tell the patient she has CFS or fibromyalgia and that I am a national expert on these diseases, because the patient is likely to call my office and try to become my patient, quoting you verbatim. Those are diagnoses I try VERY HARD to avoid, so you won't have succeeded in your revenge because I will decline to accept the new patient. The patient is likely also to cite you as the source, so I will know where the referral came from!

I'm only half-kidding; the thing is, docs that don't want to take care of patients will find ways to avoid doing it, and you and I are never going to change them. Let's just hope they don't hurt too many patients ...

dear anonymous, seems like you have a pretty good handle on it already, but here are some evil twists.

1. your hospital probably has a 15 minute call back policy. call back in 14:59 every time

2. argue with us about every consult and admission as to why this patient is not now your problem and is really someone else's problem

3. hang up on us and then call back and say you were disconnected

4. if you are placed on hold waiting for us do not wait on hold for more than 15 seconds

realize however, that due to EMTALA, we do have an unbeatable card and it is the following... "are you refusing to see the patient." if you say no then hustle on in. if you say yes then kiss your priveleges goodbye along with some $$.

Dear 911, Please go to and direct all others to go To Kevin MD's website and take in all the comments about this issue. Like many blogsites this can often be an echo chamber. Check out how the rest of the world feels about asswipe ED docs's.

Let me ask Anon a different question. What would make me an "asswipe er doc"?

I do appropriate workup on each patient. I try to only admit patients to the hospital who really need it. I do my best not to call someone at 3am, rather hold onto the patient until toward the end of my shift when possible. The consultant never knows about these courtesies.

Yet, (and I'll use an example from this past week) when I am forced to admit an unpleasant case 18 year old post partum, non-lethal overdose suicide attempt, post partum depression with a temp of 101 and endometritis....the OB/Gyn screams at me that he doesn't take care of psych patients and slams the phone down.

OR....(and I'll use an example from last week) I have a hypoxic COPD patient with a PE who is an established patient of one of the pulmonary groups in town whose on call guy says: "just why the f**k does this guy need a pulmonologist? Doesn't he have an internist?"

Due to numerous incidents like these, we have begun to record ALL calls to consultants.

Funny, but these same people who behave like assholes on the phone are the first ones to expect favors from us. They tell their office to send patients to the ER when they're busy (then seem surprised when we call them). They send folks to us and ask us to admit them. They accept transfers and ask us to assess them. They call and ask if we'll please see their friend who is in the waiting room with a non-emergent complaint ahead of others who are patiently waiting.

911: I really do enjoy your blogsite and you've every right in the world to rant on YOUR site about asswipe consultants, who certainly DO exist. I know this because I get caught in the crossfire as you and they battle over who's to manage a patient. Your attempt at a pithy retort suggesting I suffer from fibromyalgia (huh???) is not answering the question I posed and which erdoc85 poses more directly.

If you'll permit me to respond:Let me tell you about "a$$wipes" I've dealt with over my weekend on call.

Called in to deal with foreign body deep in the pharynx. GI declined the consult saying they wouldn't be able to visualize it if it were above the pharyngo-eosphageal junction. In I drive 16 miles only to discover that a shard of poultry bone is superficially embedded in one of the tonsils- a finding which would have been evident to the ED doc if he'd BOTHERED TO EXAMINE THE PATIENT (instead of getting a CT scan). It could have been removed by anyone with a flashlight a pair of tweezers. Ooops.

I get called to come to take care of a nosebleed that just won't quit. What has the ED doc done? Made one pass at sticking a stupid little sponge into the nostril. SURPRISE! Those damned things don't work. I inform the ED doc that I'll come in only after he's made a good faith effort to place a REAL pack in the patient's nose. I hear nothing further from him that night. Funny what happens when you actually do the right procedure.

This situation repeats itself the next day. Likewise I compel the doctor to do the right thing and I hear nothing further.

I get called in near midnight to pack a nose on a patient that had a pair of sponges stuck in his nose by another ER before being turfed to our hospital. SURPRISE! Those damned things don't work- or they DO work, at least long enough to get the patient out of the ED.

When I stop getting stupid calls from the ED and don't have to re-do their shoddy work, I'll develop a better attitude.

dear dr kranky, what the fuck do you want me to do? get all asswipe ED docs out of the profession. you give me far too much credit. i may even be one myself. i do not understand why you have taken this personally unless it's a little close to home. please do try to un-krankify yourself or i will remain convinced that you suffer from fibromyalgia or chronic fatigue syndrome.

dear anonymous, can you read? this post was always intended to be humorous, and, except for you, everyone has taken it that way. no, i do not refer patients out of the ED with the diagnosis of CFS or fibro and just thought it was a funny idea. in fact, if you read the post you will see that the group of consultants i refer to as 'asswipes' is a vanishingly small group. i love most of my consultants and we are collegial to the max. there are one or two out of our staff of 250 that are asswipes. one or two. there have been one or two everywhere i have worked. big fucking surprise.

yes, there are asswipe ED docs and as you will see from my last post i admit that i may even be one myself. yes i can dish and take at the same time, and, though i am very against ad hominem attacks you have proved, by your lack of humor and poor reading skills that you are a fucking idiot.

please go elsewhere and ruin someone else's day. i even made suggestions as to how to deal with asswipe ED docs which you evidently ignored. yes it's a two way street. yes we are all guilty. now go away and take some remedial reading classes and watch the three stooges and please don't darken this doorway again.

to all readers who give a shit at this point. i have deleted, and will continue to delete, all posts on THIS post from an anonymous commenter who evidently wants to fight. once more for effect, this post was and is a joke and was intended to produce a chuckle or two. anonymous, you may find an outlet for your frustrations by starting your own blog. you might want to call it 'asswipe anonymous'. the end.

The asswipe street may be two ways, but administration, staff and partners have a way of weeding out the ED docs, whereas the internists/consults can continue to exist without answering to so many people/press ganey scores/and god-forbid national contract groups.